Case discussion: How would you treat this patient? [26 March]
This week we have an interesting case from Dr Colin Armstrong. An elderly gentleman presented for a skin check, and a very obvious dark lesion on the lower back was noted.
Please review and describe the clinical and dermoscopic image. What is your evaluation, and proposed next step/s?
Here is the pathology report. What would you do next and why?
The sections show Clark level 4 malignant melanoma of superficial type. There is a nodular invasive component with a Breslow thickness of 1.9mm. Four dermal mitoses are identified per mm2. The epidermis is focally thinned, however, no ulceration is identified. No lymphovascular invasion, perineural infiltration or satellite nodules are identified. No significant tumour infiltrating lymphocytes are seen. There is no evidence of established regression. Clark level 4 malignant melanoma is completely excised with the following margins:
deep – 8mm
3 o’clock – 7mm
9 o’clock – 10mm
12 and 6 o’clock – greater than 10mm.
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.